A Study on Variations of Branching Pattern of Renal Artery with its Clinical Significance

Background The kidneys are supplied by a single renal artery originating from abdominal aorta. However, recent literature reports great variations in renal blood supply. Hence, it becomes mandatory for the clinicians to understand the abnormality and variations in the renal vasculature. Objective To evaluate the branching pattern of renal artery and its variations. Method The study consisted of Computed Topographic images of 206 kidneys. Numbers and branching pattern of renal artery were recorded. The data was analyzed for presence or absence, source of origin and type of accessory renal artery. Result The present study revealed that 73.79% of kidneys were supplied by a single renal artery, 25.72% by double renal artery and 0.49% by triple renal artery. The hillar branching pattern was recorded in 38.83% and early branching pattern was in 34.95%. The presence of accessory renal artery was recorded in 26.21%. They were originated from abdominal aorta in 22.81% and 3.40% from main renal artery. The prevalence of superior polar artery was found in 6.79%, hilar in 10.19% and inferior polar in 9.22%. Conclusion The knowledge of variations of renal artery becomes essential for the clinician to plan the adequate surgical procedures and to avoid any vascular complication.

A Study on Nutritional Status of Rural School going Children in Kavre District

Background Childhood is a time of active growth in terms of physical size, mental, emotional and psychological development. Normal growth is dependent on adequate nutrition and encompasses major transformations from birth to adulthood. Nutrition is a focal point for health and well being; and has special significance in countries with disadvantages in socioeconomic and hygienic standards. Objective The objective of the present study was to assess the nutritional status in terms of prevalence of underweight, stunting and thinness among rural school going children. Method The present study was cross-sectional study, conducted on 438 rural school going children (169 male and 259 female) with the age group 4-16 years, during the period from April 2014 to July 2014. Age was recorded in year; height and weight were measured in centimeter and kilogram respectively. BMI was calculated by using standard equation. Result The present study concluded that the nutritional status in terms of prevalence of underweight, stunting and thinness were found to be 30.85%, 24.54% and 10.05% respectively among rural school going children of Kavre district. It was revealed that 37.87% was underweight, 29.59% was stunted and 11.25% was thinness among male children whereas in female children, 26.27% was underweight, 21.24% was stunted and 9.27% was thinness. Hence, high prevalence of underweight, stunting and thinness were observed in male than in female children. Conclusion The present study has successfully documented the nutritional status in terms of prevalence of underweight, stunting and thinness among the rural school going children of Kavre district. The results of the present study will be useful for policy makers in their endeavor to formulate various developmental and health care programs.

A Study on Variations of Nutrient Foramen of Humerus with its Clinical Implications

Background Nutrient foramen is an opening into shaft of humerus which gives passage to the blood vessels of medullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting and more recently in microsurgical vascularized bone transplantation. Objective To determine the number, location and direction of nutrient foramen and whether the nutrient foramens obey the rule of ossification, that is directed away from the growing end of the bone or not. Method The present study consisted of 253 (108 right and 145 left) dried humeri excluding any fracture or pathological abnormalities during the period of 15th December 2014 - 14th February 2015. Number and direction of nutrient foramen was observed in each humerus. Location of nutrient foramen in relation with surfaces and zones of humeri was determined. Result It has been observed that 60.87% of the humeri had a single nutrient foramen, 28.85% double foramen, 6.32% triple foramen and 1.98% of humeri had four nutrient foramina where as 1.98% humeri did not have any nutrient foramina. It was concluded that the majority (88.86%) of the nutrient foramina were present on the antero-medial surface, 6.52% on the anterolateral surface and 4.62% on the posterior surface of the shaft of humeri. It was also concluded that most (94.84%) of the foramina present in the zone II followed by zone III (4.62%) then by zone I (0.54%). All foramina were directed toward the lower end of humeri. Conclusion By knowing the number and location of the nutrient foramina in humerus would be useful in preventing intra-operative injury of nutrient artery during orthopedic, plastic and reconstructive surgery and will also be relevant in medico legal practice.

Use of head circumference as a predictor of height of individual

BACKGROUND

Establishing personal identity is one of the main concerns in forensic investigations. In forensic anthropology, estimation of height from head circumference has a significant role in establishing personal identity.

OBJECTIVE

The objective of the present study was an attempt to understand the relationship between height and head circumference of an individual and to derive regression formulae to estimate the height from the head circumference.

METHOD

The present study consisted of 440 (258 male and 182 female) students of age group 17 to 25 years studying in Kathmandu University School of Medical Sciences, Dhulikhel, Nepal during the period from November 2012 to October 2013. Height and head circumference of an individual were measured in centimeter. Data were analyzed by using statistical software SPSS-16.

RESULT

The findings of the present study were significant correlation between height and head circumference (r = 0.443, p < 0.01 for male, r = 0.302, p<0.01 for female, and r = 0. 398, p < 0.01 for combined (male and female). The regression equation for height and head circumference was found to be Y = 1.734X + 70.36 (R2 = 0.196) for male, Y = 0.916X + 106.8 (R2 = 0.091) for female, and Y = 1.648 X + 71.69 (R2 = 0.158) for combined (male and female), where Y is the height of Individual and X is the Head Circumference.

CONCLUSION

Head circumference showed highly significant positive correlation with individual's height. Therefore, the present study will help in medico-legal cases in establishing the identity of an individual and this would also be useful for Anatomists and Anthropologists.

Bactericidal effect of trypan blue and fluorescein sodium in ophthalmic practice

OBJECTIVE

Trypan blue and fluorescein sodium are two commonly used dyes in ophthalmic practice. The staining of anterior lens capsule is achieved using trypan blue while fluorescein finds its application in fluorescent angiography. We assessed the 'in vitro' bactericidal effect of these two agents.

MATERIALS AND METHODS

The cidal properties of these two dyes were tested in vitro against thirty representative strains of four commonly isolated bacteria from the eye. The concentration of dyes used were 0.6 mg/ml, 0.1 mg/ml, and 0.05 mg/ml for trypan blue and 20 mg/ml, 10 mg/ml and 5 mg/ml for fluorescein sodium.

RESULT

We found that trypan blue and fluorescein sodium at an optimum concentration of 0.6 mg/ml and 20 mg/ml respectively could produce a significant fall (p less than .05) in the bacterial count of representative Gram positive and Gram negative bacteria.

CONCLUSION

The use of prophylactic antibiotics/antiseptic eye drops can be avoided if these two dyes are used at an optimum bactericidal concentration but side effects of the same at these concentrations need to be kept in mind.

Ocular angiostrongyliasis in a child--first case report from India

A rare case report of Angiostrongylus cantonensis (rat lung worm) from the eye is presented here. This worm generally causes eosinophilic meningo-encephalitis and accidentally infects humans by ingestion of uncooked snails, slugs, frogs etc. The child was presented to us with diminished vision in left eye. Slit lamp examination showed an actively motile worm in the anterior chamber. Surgical extraction of the worm was performed and it was identified as A. cantonensis. This is the first case of ocular A. cantonensis infection from India with no signs or symptoms of meningitis. After surgery, the visual acuity of the patient returned to normal.

Spectrum and antibiotic susceptibility pattern of bacterial isolates from conjunctival swabs

Conjunctivitis is the most common disease of conjunctiva which occurs by exogenous or endogenous source. Bacterial conjunctivitis is the most common type of this infection for which emperical treatment is started without knowing the etiological agents because prior cultures are generally not taken. We conducted this survey to study the etiological agents of conjunctivitis in a total of 6763 swabs obtained over a period of four years (2001 to 2004). The prevalence of bacterial conjunctivitis was found to be 20.4% with a predominance of Staphylococcus aureus (87.2%) followed by Streptococcus pneumoniae (4.7%) and gram negative rods (E.coli + Klebsiella spp. + Pseudomonas spp.) in 8.1% swabs. For S. aureus, amikacin showed maximum sensitivity (73.2%) while for S. pneumoniae, cefotaxime (90.6%) and cefazolin (89%) were found to be highly sensitive drugs. For gram negative rods, ceftazidime (74.1%) and cefotaxime (67%) were found to be preferred options. Thus it is concluded that bacterial conjunctivitis in our hospital is predominated by S. aureus. The bacterial isolates obtained from conjunctiva have not yet attained a high level of antibiotic resistance and hence averts the need to unnecessarily start new/latest generations of antibiotic eyedrops or antibiotic combination which may lead to acquisition of resistance by these bacteria.

Phacoemulsification after penetrating keratoplasty with autologous limbal transplant and amniotic membrane transplant in chemical burns

We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months' follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.

Tubercular preseptal cellulitis in children

OBJECTIVE

To present the clinical findings in 7 patients with preseptal cellulitis caused by tuberculosis.

DESIGN

Retrospective noncomparative interventional case series.

PARTICIPANTS

Seven patients.

METHODS

Review of clinical findings, course, diagnostic tools, and management of 7 cases with tubercular preseptal cellulitis.

MAIN OUTCOME MEASURES

Healing of local and systemic lesions, cosmetic correction.

RESULTS

The presenting features of tuberculosis included lid abscess formation in 5 cases, with spontaneous fistulization in 2 patients. Two cases were initially seen with a cicatricial ectropion of the upper lid. A history of a lid swelling with spontaneous fistulization was present in both cases. Nonresponsiveness of the lesions to systemic antibiotics led to a detailed evaluation of the patients, and evidence of an underlying active or healed systemic focus was present in all the cases. Acid-fast bacilli from pus from the discharging sinuses were identified in only 1 case, and in another patient, a biopsy specimen of the submandibular lymph node showed caseation necrosis. In the other cases, the diagnosis was presumptive from a strongly reactive Mantoux test, raised erythrocyte sedimentation rate, and the presence of a systemic focus. All the patients showed a dramatic response with antitubercular treatment, with complete healing of lesions. Two patients had a residual cicatricial ectropion, which was corrected surgically in both cases.

CONCLUSIONS

Preseptal or lid involvement can be the presenting feature of tuberculosis and a marker for underlying systemic focus in children. Spontaneous fistulization of the abscess, minimal inflammatory signs, nonresponsiveness to antibiotic therapy, tethering to the underlying structures and skin, and the presence of a cicatricial ectropion should alert the clinician to look for an alternate diagnosis. The lid presentation might be a marker of an underlying systemic focus; therefore, awareness of the many faces of tuberculosis is important for ophthalmologists.

Posterior continuous curvilinear capsulorhexis with and without optic capture of the posterior chamber intraocular lens in the absence of vitrectomy

PURPOSE

To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery.

PATIENTS AND METHODS

Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed.

RESULTS

The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of follow-up. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P > .05).

CONCLUSION

PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy.

Modified grey line split with anterior lamellar repositioning for treatment of cicatricial lid entropion

To determine the success rate of surgery of modified grey line split with anterior lamellar repositioning in patients with cicatricial lid entropion and to determine the risk factors of failure of the procedure, 40 patients (84 lids) with either lid involvement caused by cicatricial lid entropion of different etiologies were enrolled in this study. All the lids were operated on using the technique of modified grey line split and anterior lamellar repositioning. The success of the procedure was assessed by restoration of anatomical and physiological functioning of the lid without any residual symptom to the patient. Patients were examined initially at weekly intervals for 1 month and subsequently followed up at 2, 3, and 12 months following surgery. Among the various causes for cicatricial lid entropion, infectious etiology (72/84 lids) was found to be the most common one. A success rate of modified grey line split with anterior lamellar repositioning was 88.09% (74/84 lids). The underlying etiology of cicatricial lid entropion was the sole predictor of failure of surgery. Those with the etiology of infection had more than 6 times the odds of surgery failure (OR: 6.73; 95% CI: 2.79-16.73) as compared to a patient without infectious etiology. The role of other factors such as the age of the patient, degree of entropion, previous entropion surgery, the lid (upper or lower) involved, irregular lid margin, and defective lid closure were statistically insignificant. The underlying etiology of cicatricial lid entropion is the only risk factor that significantly influences the outcome of surgery with this technique. Otherwise, this procedure gives good results with fewer complications in patients with cicatricial lid entropion.

Efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique

OBJECTIVE

To determine the efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by the tarsal fracture technique.

METHODS

Fifty patients (92 lids) diagnosed as having cicatricial lid entropion were operated by the tarsal fracture technique. There was defective lid closure in 34/92 lids, irregular lid margin in 48/92 lids, distichiatic or metaplastic cilia in 28/92 lids and a history of previous entropion surgery in 34/92 lids. All patients were followed up for one year and the surgical failures at the end of this period were subjected to lamellar division. These subjects were further followed up for one more year.

RESULTS

An overall success rate of 28.26% (26/92 lids) was obtained with the tarsal fracture technique. A correction was achieved in all the 20 lids having cicatricial entropion without any associated features. However, this technique succeeded in only six of the remaining 72 lids (8.33%) with a history of previous surgery or the associated features stated above. Furthermore, it was not effective in correcting associated anomalies such as defective lid closure, irregular lid margin and distichiatic or metaplastic cilia. Reoperation using lamellar division gave good correction in 97% of the lids (64/66).

CONCLUSIONS

Lamellar division is a better procedure for treating cicatricial lid entropion, especially in patients with associated complications or with a previous history of entropion surgery.

Methanol-induced optic neuropathy: treatment with intravenous high dose steroids

The aim of this study was to find the potential benefit of intravenous high dose steroids in the treatment of patients with methanol optic neuropathy. Four patients complaining of diminution of vision after taking methylated spirit presented to us within a variable period of its consumption. The systemic features of methanol poisoning were absent in these patients. Raised blood levels of methanol confirmed the diagnosis of methanol optic neuropathy. All these patients received high doses of intravenous steroids for three days, followed by oral steroids, 1 mg/kg body weight, for 11 days. The administration of high doses of intravenous steroids led to an improvement of visual status in all four patients. Intravenous high dose steroids benefit the visual status of patients with methanol-induced optic neuropathy, provided the interval between the consumption of methanol and starting treatment is short. Further studies should be undertaken to document the role of intravenous steroids in this context.

Tubercular endophthalmitis simulating retinoblastoma

PURPOSE

To report a case of tubercular endophthalmitis simulating retinoblastoma.

METHODS

Case report. An 8-year-old female presented with a history of complete loss of vision and a white pupillary reflex in the left eye of 3 month's duration.

RESULTS

Retinoblastoma could not be excluded on the basis of clinical examination and relevant investigational studies. In the left eye, a computed tomography (CT) scan demonstrated a large vitreous mass with foci of calcification. Enucleation in the left eye was performed, and histopathological examination revealed a chronic granulomatous endophthalmitis and acid-fast bacilli consistent with tubercular pathology.

CONCLUSION

This case illustrates that tubercular endophthalmitis with leukocoria and a vitreous mass containing focal calcification may simulate retinoblastoma.

Disposable contact lenses in penetrating keratoplasty

PURPOSE

To evaluate the therapeutic efficacy of disposable contact lenses in management of complications after keratoplasty.

METHODS

Twenty-eight patients with various post keratoplasty complications were fit with disposable contact lenses (45% Vifilcon A and 55% water content). Indications for lens use included persistent epithelial defects, wound leak, graft edema, dry eye and protection of normal corneal epithelium.

RESULTS

Success was obtained with the therapeutic use of disposable lenses in 20 of the 28 cases. The best results were seen in maintenance and restoration of healthy ocular surface and small wound leaks. Stromal graft edema with no epithelial involvement was the major area of therapeutic failure.

CONCLUSIONS

Disposable contact lenses are an attractive low cost option in the management of complications after keratoplasty. They are particularly useful in maintaining a healthy ocular surface, providing symptomatic relief and avoiding resurgery in patients with small wound leaks.

Polyglactin sutures versus nylon sutures for scleral flap suturing in trabeculectomy

BACKGROUND AND OBJECTIVES

To note the effect on filtration function of using polyglactin sutures for scleral flap suturing in trabeculectomy.

PATIENTS AND METHODS

Polyglactin sutures were compared with nylon sutures to secure the scleral flap of trabeculectomy in 30 consecutive eyes. Parameters studied were intraocular pressure, central anterior chamber depth, and bleb score in this randomized prospective study.

RESULTS

Observations regarding intraocular pressure, central anterior chamber depth and bleb score in the early postoperative period were comparable in the 2 groups. The results at 12 months follow-up reveal a lower mean IOP (P < 0.05) and a higher mean bleb score (P < 0.05) in the group with polyglactin sutures. Success rate (defined as IOP < 21 mm Hg) at 12 months was 100% with use of polyglactin sutures compared to 80% with nylon sutures.

CONCLUSIONS

Polyglactin sutures can be used as an alternative to nylon sutures for scleral flap suturing in trabeculectomy, with the possible additional benefit of better long-term filtration function.

Seroepidemiology of ocular toxoplasmosis-profile of an urban population

200 uveitis cases and 100 controls were serologically analysed for Toxoplasma antibodies (Ab) using indirect fluorescent antibody test (IFAT-IgG, Igm) and enzyme linked immunosorbent assay (ELISA IgG, IgM). Ophthalmologically cases were segregated into 4 groups anterior uveitis, posterior uveitis, pan uveitis and varied presentation uveitis. Toxoplasma seropositivity of 32% in cases and 4% in controls was established. IHA, IFAT, ELISA detected 20%, 18% and 32% cases as seropositive respectively, IFAT being most specific (100%) and ELISA most sensitive (41.37%). Insignificant change in Ab titre was observed in sequential samples of seropositive cases. Posterior Uveitis cases had the maximum seropositivity (41.7%). Highest seropositivity was in 16-25 years age group with no sex preponderance. Dietary habits and occupational history had no bearing on Toxoplasma infection. Results indicate that serology in mandatory for diagnosing Toxoplasma as a cause of uveitis, 2 or more tests on a single serum sample detecting IgG and Igm Ab are the best indicators of infection.

Pulmonary tuberculosis in Ahmedabad: epidemiology, diagnosis and short course chemotherapy

Five hundred children below the age of 12 years suffering from lung tuberculosis viz., primary complex (PC) or progressive primary complex (PPC) were studied. Diagnosis was based on Kenneth Jones criteria; selected cases having score of 5 or more. One hundred and eighty cases of PC were given A-1 (6 RH) regimen, while 312 cases of PPC were given A-2 (2SHRZ/4 RH) or A-3 (2 SRH/4 RH) or A-4 (2 RHE/4 RH) regimen. Follow-up was done for 6 months after completing the treatment to observe the relapse rate. In cases of PC, 6 RH regimen appeared adequate and cheaper with no relapse rate. In cases of PPC with short course chemotherapy, compliance of patients had been very good. Relapse rate was up to 13% which is acceptable. Drug toxicity was very low.

Bilateral tubercular lid abscess--a case report

Tuberculosis is a ubiquitous disease and a public health problem of major importance in almost all countries. The disease can involve any part of the body. Eye involvement to tuberculosis is also common. A case of bilateral tubercular lid abscess without any active systemic involvement is being reported because of its rare occurrence.

A new treatment of pthiriasis palpebrarum

Treatment of phthiriasis palebrarum so far is unsatisfactory and prolonged. It was an accidental finding that led us to try various strengths of fluorescein on head lice. It was seen from our study that 20% fluorescein resulted in the lice' instantaneous death. This percentage was used in all our subsequent cases of phthiriasis with excellent results. A new method for the treatment of phthiriasis palpebrarum from the eyelash by a single application of 20% fluorescein is described. This method required no sedation or anesthetic and can be carried out as an outpatient department procedure. It is nontoxic and not irritating. There is no risk of the physician being infested, as the lice and nits are killed instantaneously.

A simple method of assessment of gestational age in newborn infants

A simple method of assessment of gestational age based on only four characteristics, namely, the anterior vascular capsule of the lens, plantar creases, breast nodule, and ear firmness, is presented. Critical evaluation by appropriate statistical analyses has shown this to be a useful method of practical value with 95% confidence limits of 11 days. It is applicable to newborn infants, including sick babies, at any time within the first 2 days of life.